Immediate implant placement in a site with severe buccal dehiscence
Dr. Ferdinando D'Avenia
Italy
“creos™ xenogain is a user-friendly bone grafting material: hydration, manipulation and positioning is simplified by its wettability coupled with a smart syringe packaging that really makes things easy.”
Patient: male, 60 years old
Clinical situation: chronic periodontitis. Tooth # 25 with porcelain fused to metal crown and metal post and core. Vertical root fracture occurred two months earlier. 10 mm “U” shaped buccal dehiscence.
Surgical solution: Immediate implant placement (NobelParallel™ CC RP 4.3 x 13 mm) in combination with a GBR procedure (using creos™ xenogain and creos™ xenoprotect).
Restorative solution: NobelProcera® Zirconia Abutment
Surgery date: May 9, 2016 (GBR)
Total treatment time: 7 months
Initial clinical situation
Initial situation: pre-operative CBCT images (left).
Clinical pre-surgical situation (right).
Surgical procedure
After atraumatic tooth extraction, the granulation tissue is completely removed. The osteotomy is prosthetically driven, in order to provide a second premolar screw retained restoration with an occlusal screw access hole. In order to satisfy this criteria, the implant is more favorably housed in predominantly native bone, mesio-lingually to the center of the defect (left).
The implant (NobelParallel™ CC RP 4.3 x 13 mm) is placed with 20 Ncm insertion torque, with buccal threads exposed to the defect area (without bone contact) (right).
Surgical procedure
Placement of creos™ xenoprotect inside the extraction socket to protect creos™ xenogain from exposure to the soft tissue through dehiscence (left).
Hydration of creos™ xenogain with venous blood (right).
Surgical procedure
Placement of creos™ xenogain into the bony defect. The implant is covered with a 3 mm healing abutment (Ø 3.6 mm) (left).
Healing after 8 days with slight membrane exposure (right).
Surgical procedure
Post-operative CBCT showing sufficient bone augmentation of the buccal wall dehiscence (left).
120 day follow-up: during the final impression visit, the healing abutment is changed. A wider diameter allows a better management of the final restoration emergency profile (right).
Restorative procedure
CBCT after healing.
Outcome
Final restoration.
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NobelParallel™ Conical ConnectionA simply straightforward implant system.
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creos™ xenoprotectA membrane with outstanding handling that facilitates bone gain.
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creos™ xenogain3 methods of application to meet all your bone grafting needs.
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